Sandra Jumbe

The increasing mental health gap in low- and middle-income countries (LMICs) represents a significant global public health concern. Access to mental healthcare remains challenging due to stigma, lacking quality treatment options, and skilled workforce shortages. Tele-mental health, which involves remote access to care through information and communications technologies (ICTs) and mobile communication systems, may represent a promising solution. However, most research in this area has been conducted in high-income countries. This scoping review aimed to explore known barriers and facilitators to implementing tele-mental health solutions to populations in remote, rural, and underserved communities in LMICs to inform evidence-based development and implementation of digital interventions and strategies that can improve access to quality and affordable mental healthcare. Studies published between 2010 and 2024 were identified through comprehensive searches across four databases, namely PubMed, PsycINFO, Web of Science, and SpringerLink. Nine studies were included for analysis. Barriers and facilitators were categorised using the Capability, Opportunity, and Motivation = Behaviour (COM-B) model. A narrative synthesis revealed several barriers for patients, primarily related to limited physical and social opportunities, such as lack of mobile devices, unstable or limited internet access, and lack of private space at home. Barriers for mental health providers were predominantly linked to psychological capability, including insufficient knowledge concerning tele-mental health interventions. Time and cost efficiencies were key facilitators for both service users and mental health service providers, which enhanced access to care. Infrastructure development, educational initiatives, and training for providers are essential to create a more equitable tele-mental healthcare system.

Mental health literacy (MHL) in Malawi is low. Mental illness is often attributed to substance abuse or spirit possession, resulting in stigma, maltreatmen

Background: Mental health literacy (MHL) is the ability to recognise mental disorders; have knowledge of professional help available, effective self-help and prevention strategies; and have the skills to support others. MHL is linked to better help-seeking behaviours and better management of mental illness. Mental illness prevalence is increasing in Malawi. Assessing MHL in communities crucially helps identify knowledge gaps, informing the development of evidence-based interventions. Aims: This study assessed the MHL levels of young adults (16–30 years old) in rural and urban communities in Malawi. Method: A cross-sectional national survey was administered to 682 people across 13 districts in Malawi, using a self-reporting Mental Health Literacy questionnaire (MHLq) that assessed knowledge of mental health problems, erroneous beliefs/stereotypes, first aid skills, help-seeking behaviour and self-help strategies. Results: Most respondents were either unemployed (36%) or enrolled in school (43%). A total of 73% completed primary or secondary education, and 48% knew someone with a mental illness, but only 14% of this group could specify the illness. The mean MHL score was 111.8 (s.d. 13.9). Individuals with primary and secondary school qualifications had significantly lower scores in factor 2 (erroneous beliefs/stereotypes) and factor 3 (first aid skills and assistance-seeking behaviour) of the MHLq than those with higher education. Conclusions: This research highlights persisting mental health misconceptions, limited knowledge about specific mental illnesses and low help-seeking behaviour among young adult Malawians. Higher education is linked to a better understanding of mental health. Prioritising community education on causes, signs, treatments and prognosis of mental illness is crucial for increased MHL.

In Malawi, mental health resources remain limited while demand continues to rise, particularly among young people, resulting in a substantial treatment gap. Enhancing mental health literacy (MHL) is increasingly recognised as a preventive strategy to reduce the onset and escalation of mental disorders. MHL is commonly assessed through instruments evaluating knowledge, beliefs, self-help strategies, and help-seeking behaviours. Although previous studies in Malawi have explored mental health awareness, none have directly measured MHL among young people, and few have addressed the cultural adaptations necessary for contextual validity. Such adaptations are essential to support decolonising research practices and to generate accurate insights into local understandings of mental health. This explanatory mixed-methods study examined the applicability of a Portuguese-developed Mental Health Literacy Questionnaire (MHLq) among young people in rural Malawi. Quantitative data ( n = 107) were statistically analysed, followed by qualitative focus groups ( n = 7) to interpret and contextualise findings. The dataset yielded moderately high mean MHL scores, contrasting with participants’ perceptions that mental health literacy in Malawi remains low. Thematic analysis identified three central themes: (a) epistemic exclusion, (b) conceptual misfits, and (c) translation challenges. Findings highlight the need to adapt the MHLq to incorporate culturally relevant knowledge, linguistic nuance, and local conceptualisations of mental health. Avoiding psychiatric terminology that lacks direct Chichewa equivalents is particularly important. The study underscores the necessity of participatory, contextually grounded approaches for developing and validating MHL tools in low-resource, culturally diverse settings.

During the COVID-19 pandemic, various aspects of life were s ignificantly disrupted due to ill health, economic instability, and reduced social interactions precipitated by pandemic related restrictions. These disruptions exacerbated stress among young populations across the globe. This qualitative study explores how the pandemic affected the mental health of young Africans aged 18 to 24 years residing in Malawi and Sudan. We conducted six focus group discussions (FGDs), with 25 participants from Malawi and Sudan. Participants were recruited through a poster posted on Facebook and X (previously Twitter). These FGDs were recorded, transcribed verbatim, and analysed using thematic analysis. Three key themes emerged from the analysis: (1) main challenges facing youth, including economic hardship, social pressures, and limited educational and employment opportunities; (2) stigma, lack of awareness, and limited availability of trained professionals as barriers to accessing mental health services; and (3) recommendations for improving mental health service delivery. Across these themes, participants voiced a need for community outreach, integrating mental health into primary care services, and providing culturally sensitive support tailored to the needs of young people. This study highlights key mental health challenges faced by young people in low-resource settings during the COVID-19 pandemic, emphasising the need for tailored policies to support youth mental health during and after pandemics. Results underscore the need for community-based approaches to enhance mental health literacy and develop youth-focused mental health services in Malawi and Sudan. This research also provides valuable insights into potential preventive measures and interventions needed to mitigate these effects.

Background Mental health literacy (MHL) in Malawi is low. Mental illness is often attributed to substance abuse or spirit possession, resulting in stigma, maltreatment, and discrimination towards people with mental health problems. Inadequacies in Malawi's mental health services and workforce increase limited treatment access, knowledge, and negative attitudes, causing an epidemic of substance use and suicides. MHL is foundational for mental health promotion, prevention of mental illness, and stigma reduction. Educational settings are ideal for implementing mental health promotion activities. We want to deliver a MHL e-curriculum (MHLeC) to first year university students in Malawi to improve their MHL. The project aims to assess the feasibility of implementing MHLeC in four Malawian universities within a cluster randomised trial. Methods In this pragmatic, cluster randomised feasibility trial, we will approach four to eight public and private tertiary institutions about study participation. Clusters will be participating universities allocated to the mandatory MHLeC or the voluntary MHLeC group using stratified randomisation on a 1:1 ratio. University characteristics (e.g., public or private, number of first-year students enrolled, and information technology (IT) infrastructure) will be used to stratify randomisation. Specific feasibility objectives include 1) estimating likely participation rates of universities and students 2) establishing potential attendance /retention rates during MHLeC delivery 3) assessing acceptability of the MHLeC through qualitative feedback after intervention delivery 4) assessing appropriateness of chosen questionnaires for measuring student outcomes. Data will be analysed descriptively. Outcomes from data collected will inform feasibility of a future main trial including main trial design and recruitment strategies, sample size and power calculations for a full-scale cluster randomised trial. Discussion This trial will give us insights on how best to conduct the definitive trial. The intervention can be rolled out nationally within a full-scale trial in Malawi and tested in similar cohorts across Africa if positive results are obtained. More broadly, this research has the potential to significantly increase mental health awareness among young people in Malawi. Trial registration: This study is registered on the Pan African Clinical Trials Registry (PACTR) website https://pactr.samrc.ac.za/ (PACTR202308849574524). Registered 31st August 2023.

Background and aims: Adolescent substance use is a growing public health concern in Africa, yet little is known about the contextual factors of substance use among young African populations. This systematic review identified factors associated with substance use among adolescents (aged 10–19 years) in Africa. Methods: This review was conducted in line with PRISMA guidelines. We searched six databases (from January 2000 to December 2020): PubMed, Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and World Health Organization (WHO) African Index Medicus. We included population‐based observational studies reporting on factors associated with adolescent substance use across Africa. Study screening was conducted by at least four independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analysed in a narrative synthesis. Studies providing sufficient statistics, i.e. three or more reporting the same outcome and exposure/predictor, were included in meta‐analyses. Results: Sixty‐three peer reviewed studies that were full text accessible were included. The majority were cross‐sectional surveys. Factors associated with adolescent substance use identified were linked to individual, family, socioenvironmental and non‐familial social networks determinants. Results from both the narrative synthesis and meta‐analysis revealed that being male and an older adolescent were significantly associated with adolescent substance use. Combined odds ratio (OR) of males who currently smoke compared with females was 1.81 [95% confidence interval (CI) = 1.37–2.39; 6 studies, 13 443 participants, I ² = 59.67%]. Additional meta‐analysis outcomes found that having a friend who smokes was associated with tobacco smoking. Combined OR of ‘ever‐smokers’ with a friend who smoked was 4.83 (CI = 2.56–9.10; 3 studies, 18 858 participants, I ² = 79.21%). Having a family member who smokes was associated with smoking initiation (OR = 2.99; CI = 2.67–3.35; 3 studies, 18 858 participants, I ² = 0%) and current smoking (OR = 2.33; CI = 2.23–2.45; 4 studies, 13 282 participants, I ² = 0%). Conclusion: Multiple factors that operate on individual, family and societal levels influence adolescent substance use in Africa. Key factors of adolescent substance use in Africa appear to include being male, being an older adolescent and being exposed to peer substance use.

In Malawi, it is difficult to promote positive mental health due to poverty, cultural beliefs, and stigma associated with mental illness. Mental health literacy (MHL) is not integrated into the education system despite evidence suggesting educational settings as ideal to deliver MHL programmes. Stakeholder input is crucial during development of interventions. This paper reports on our work with diverse stakeholders to culturally adapt a MHL course (MHLc) for implementation in Malawi universities. The MHLc structure and content development involved focus group discussions (FGDs) with 44 Malawian youth from universities and youth organisations, a national MHL survey and a systematic review exploring adolescent substance use in Africa. The MHLc was delivered to 35 first‐year university students. Students’ MHL was assessed using two questionnaires before and 3 months after MHLc delivery during an evaluation session which also included FGDs with 20 participants to explore course satisfaction. MHL questionnaire responses were analysed using paired t‐tests and FGD transcripts were thematically analysed. Overall student attendance rate during the MHLc delivery was 92%. However, only 57% attended the evaluation session. Students’ MHL increased after course completion (pre and post scores were 116.7 and 117.9 respectively) however this change was not significant. Student feedback about the MHLc was positive. They highlighted acquiring considerable mental health knowledge and skills that they would utilise in their lives daily. A key challenge raised was disruption of course delivery due to electricity outages. The MHLc content was acceptable among university students with high attendance rates and positive feedback regarding impact on participants’ mental health knowledge and attitudes. This paper highlights the value of stakeholders’ input when designing mental health interventions. In future, we need to mitigate disruption of the MHLc delivery and consider incentives to reduce participant dropout at follow up points.

Mental health literacy is the ability to recognise mental disorders, have knowledge of professional help available, effective self-help strategies, prevention strategies, and skills to support others. Mental health literacy is linked to better help-seeking behaviours and the management of mental illness. The prevalence of mental illness in Malawi is increasing. Assessing mental health literacy in communities crucially helps identify knowledge gaps, informing the development of evidence-based interventions. This study assessed the mental health literacy levels of young adults (16-to-30 years old) in rural and urban communities in Malawi. A cross-sectional national survey was administered to 682 people across 13 districts in Malawi using a self-reporting Mental Health Literacy questionnaire (MHLq) that assessed knowledge of mental health problems, erroneous beliefs/stereotypes, first-aid skills, help-seeking behaviour, and self-help strategies. Most respondents were either unemployed (36%) or enrolled in school (43%). 73% had completed primary or secondary education, 48% knew someone with a mental illness but only 14.1% of this group could specify the illness. The mean mental health literacy score was 111.8 [Standard Deviation (SD) = 13.9]. Individuals with primary and secondary school qualifications had significantly lower scores in Factor 2 (erroneous beliefs/stereotypes) and Factor 3 (First-aid skills and assistance-seeking behaviour) of the MHLq than those with higher education. This research highlights persisting mental health misconceptions, limited knowledge about specific mental illnesses, and low help-seeking behaviour among young adult Malawians. Higher education is linked to a better understanding of mental health. Prioritising community education on causes, signs, treatments, and prognosis of mental illness is crucial for increased mental health literacy.